Healthcare Provider Details

I. General information

NPI: 1215702352
Provider Name (Legal Business Name): BRANDON SHULFER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 60TH ST
WEST DES MOINES IA
50266-7700
US

IV. Provider business mailing address

6000 NW 62ND AVE UNIT 213
JOHNSTON IA
50131-1530
US

V. Phone/Fax

Practice location:
  • Phone: 515-343-1700
  • Fax:
Mailing address:
  • Phone: 715-340-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24775
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number24775
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: